Clifford McDonald, MD, Associate Director for Science in the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention (CDC), chaired the conference. In his role at the CDC, McDonald’s at the forefront of efforts to prevent and treat the infection – one the CDC has declared among the most urgent drug-resistant threats that we currently face.

“It’s my firm belief that we are on the threshold of a new era in better diagnosis, treatment, and prevention approaches. At the CDC, we deal with statistics, but there are faces behind those numbers. At the heart of every infection is a patient who deserves our competence, our empathy, and our passion,” said McDonald.

One of those faces, Roy Poole, is a volunteer patient advocate for the C Diff Foundation. After retiring from a career in the Air Force, Poole led a healthy, active lifestyle as an avid outdoors-man in Colorado before antibiotics prescribed for a routine dental procedure set the stage for CDI. In the medical community, his symptoms were met with disbelief and inappropriate treatment.

“Three weeks after leaving the hospital, I walked into my (previous) primary care physician, and asked for an order to have a stool sample taken to determine if Toxins A or B were present. His response was, ‘Are you still having problems with that?’ Clearly, there is a need for more education about C. diff among physicians,” said Poole.

CDI is a formidable opponent. However, with the newly focused attention on discovering ways to disable the bacteria and cohesive public health approaches aimed at prevention, presenters from government, academia and industry offered five key reasons we can win the battle against C. diff:

Antibiotic stewardship efforts are gaining a foothold.
Statistics present a chilling picture: 453,000 new cases and an estimated 30,000 deaths each year. It’s likely that those numbers grossly underestimate the true impact of CDI, since it’s what we know from death certificate reporting.

However, we are seeing that rates may have peaked after a long plateau. Mark Wilcox, MD, Head of Microbiology at Leeds Teaching Hospital, Professor of Medical Microbiology at University of Leeds, and the lead on Clostridium difficile for Public Health England in the United Kingdom, has demonstrated a 70% reduction in cases in England in just 7 years. This was after a concerted effort that Wilcox spearheaded surrounding antibiotic stewardship, specifically addressing a reduction in unnecessary prescribing of fluoroquinolones and cephalosporin antibiotics.

Commonly prescribed antibiotics disrupt the protective microbiota (the normal bacteria of the gut) and leave it vulnerable for C. diff colonization. “There was a concerted effort that went beyond lip service and truly embraced the principles of improved surveillance, more accurate diagnostics, enhanced infection prevention measures to use antibiotics more wisely and to limit transmission and careful treatment,” said Wilcox.

High rates of CDI are always associated with the use of certain antibiotics: clindamycin, cephalosporin, and fluoroquinolones. Research has shown that lower respiratory tract infections and urinary tract infections account for more than 50% of all in-patient antibiotics use. But are these really necessary?

“We know that antibiotics are overused and misused across every healthcare setting. At least 30% of antibiotic prescriptions are unnecessary – and this equates to 47 million unnecessary antibiotic prescriptions per year written in doctors’ offices, hospital outpatient departments, and emergency departments. We have a lot of work to do, and CDC is actively working to reduce unnecessary antibiotic use,” said Arjun Srinivasan, MD at the CDC. “Stopping unnecessary antibiotics is the single most effective thing we can do to curb C. diff infections in the United States. This is something that we can do today.”

Srinivasan acknowledged that telling patients that they can’t have a prescription for an antibiotic might result in some pushback. “Patient satisfaction scores are a very real concern. When someone is sick and takes a day off work, they’re not leaving without a prescription – especially when the last provider wrote one for their same symptoms,” he said. “But this is a new day, and it’s up to the physician to educate their patients and stay strong.”

Hospitalists have access to accurate, inexpensive and quick diagnostic tests that can lead to targeted, effective treatment. This can arm the treating physician and patient with information that can put patients on a path to recovery without feeling like they are being dismissed.

Emerging guidance reflects important advances in research and development.

Most recently published in 2010, the Society for Healthcare Epidemiology of America (SHEA) and Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for C. diff are currently under review. This is critical because of the number of physicians still treating with metronidazole first, despite the fact that the largest randomized controlled clinical trial has shown that vancomycin is more effective.

“The past few years have ushered in a new age of understanding how and where C. diff colonizes, and the damaging toxins A and B that it produces.”

Considering that 25-30% of patients experience a CDI recurrence, it’s evident that metronidazole unnecessarily contributes to the failed treatment outcomes for patients. Metronidazole is less expensive, but has more side effects than oral vancomycin and is less effective in treating CDI.

Johnson provided an overview of the dramatic advances this space has seen in just the past few years.

Limitations of current guidelines include:
• No mention of fidaxomicin, a narrow-spectrum antibiotic, which in 2011 was the first medication approved in 25 years for the treatment of C. diff associated diarrhea
• Limited evidence for recommendations to treat severe, complicated CDI
• Limited evidence for recommendations on recurrent CDI
• Little mention of Fecal Microbiota Transplant (FMT)

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5. Patient advocacy and awareness efforts can alter the course of CDI.CDI survivors shared their experiences along their emotional journey – fear, disbelief, isolation, and depression. They also expressed gratitude at the validation, information and support they received from the patient advocacy community. Perhaps the greatest gift they have received is the empowerment to question their physicians about the necessity of antibiotics they have been prescribed in terms of risk of CDI.

“The hospital where I was treated initially seemed eager to have me leave. They offered no additional help. The C diff Foundation has been my greatest source of help. In turn, I feel I help myself cope best, when I help others to cope with the disease,” said Poole.

TO READ THIS ARTICLE IN ITS ENTIRETY AS PUBLISHED IN THE MD MAGAZINE

PLEASE CLICK ON THE FOLLOWING LINK TO BE REDIRECTED —- THANK YOU

Dale Gerding, MD, FACP, FIDSA, is Professor of Medicine at Loyola University Chicago, Research Physician at the Edward Hines Jr. VA Hospital. Additionally, Gerding is an infectious disease specialist and hospital epidemiologist, past president of the Society for Healthcare Epidemiology of America and past chair of the antibiotic resistance committee of SHEA. He is a fellow of the Infectious Diseases Society of America and past chair of the National and Global Public Health Committee and the Antibiotic Resistance Subcommittee of IDSA. His research interests include the epidemiology and prevention of Clostridium difficile, antimicrobial resistance, and antimicrobial distribution and kinetics.

#AntibioticResistance

November 14-20th , 2016

In recognition of Get Smart about Antibiotics Week; November 14th – 20th, 2016 — the C Diff Foundation is teaming up with the Center for Disease Control and Prevention (CDC) to participate in a number of social media events and we encourage everyone to participate.

On November 14th the CDC launched a Thunderclap campaign that resonated around the world with a powerful message to kick off the Get Smart About Antibiotics Week.

On November 18th the European Centre for Disease Prevention and Control @ECDC_EU is hosting an ALL-DAY GLOBAL TWITTER CHAT using hashtag #AntibioticResistance

CDC will be hosting part of this live Twitter chat on Friday, November 18th from 11a.m. – 1p.m. EDT @CDCgov and would love your organization to join us in the conversation.

CDC Director, Dr. Tom Frieden @DrFriedenCDC w2ill be Tweeting during the chat, and we hope that you will make plans to take part in this important conversation with antibiotic-resistance partners and experts worldwide.

The Get Smart About Antibiotics Week 2016 observance marks the second annual World Antibiotic Awareness Week, which coincides with European Antibiotic-Awareness Day, Canada Antibiotic Awareness Week, and other similar observances across the world.

There are exceptional opportunities to raise awareness of the threat of antibiotic-resistance and the importance of preserving the power of antibiotics. With that in mind, please promote your organization’s antibiotic resistance and stewardship materials and resources during the Twitter chat on Friday, November 18th.

The drive and passion takes us forward in promoting the practical and technical advancements taking place across the globe. Healthcare Professionals from every area of expertise, discussed the control and treatment options, the healthcare perspectives, antibiotic-resistance stewardship programs, and much more to raise C. diff. awareness and share successful implementations and guidelines.

This free webinar is available to you and with the ease of learning without having to travel.

The Global C. difficile Congress — eight sessions presented by topic experts – in four hours – in one day – with goals to change the C. difficile world with a common focus; To
improve awareness of C. diff. infection prevention, treatments, research, and environmental safety in the healthcare communities worldwide.

Guest Speakers and Program Topics

USA ET UK TIME GUEST SPEAKER

8:00 – 8:15 a.m. 1:00 – 1:15 p.m. Paul Feuerstadt, MD

Dr. Paul Feuerstadt; Native of Long Island, New York, Dr. Feuerstadt attended the University of Pennsylvania where he earned his Bachelor of Arts degree in Biology, with distinction in research and graduated Summa Cum Laude. Following completion of his undergraduate training, Dr. Feuerstadt attended the Weill Medical College of Cornell University in Manhattan, New York where he earned his Medical Doctor degree and stayed at New York Presbyterian Hospital/Weill Cornell medical center for his internship and residency in Internal Medicine. Following completion of his residency
Dr. Feuerstadt then moved on to the Montefiore Medical Center in the Bronx, NY for his clinical fellowship training.His areas of interest include ischemic diseases of the gut and chronic diarrheal syndromes with a specific focus on C.diff. infections.Dr. Feuerstadt is affiliated with St. Raphael campus of Yale-New Haven Hospital, Yale-New Haven Hospital and
Milford Hospital seeing outpatients in his offices in Hamden and Milford, CTTopic: Welcome – Introduction

8:15 – 8:45 a.m. 1:15 – 1:45 Jean de Gunzburg, PhD

Dr. de Gunzburg is Chief Scientific Officer of Da Volterra, an emerging biotechnology company, headquartered in Paris, France. Prior to this, Jean de Gunzburg led an academic research career in molecular and cell biology at the Institut Pasteur (Paris, France), the Whitehead Institute for Biomedical Research (Cambridge, MA, USA) and the Institut Curie (Paris, France). He is the author of over 70 publications in international peer reviewed scientific journals, and continues to serve on several grant review committees.Topic: “DAV132, A Novel Product Destined To Prevent Antibiotic-Induced
Clostridium difficile Infections.”

8:45 – 9:15 1:45 – 2:15 Arjun Srinivasan, MD

Dr. Arjun Srinivasan is the Associate Director for healthcare-associated infection (HAI) prevention programs in the Division of Healthcare Quality Promotion at the Center for Disease Control and Prevention’s National Center for Emerging and Zoonotic Infectious Diseases. Dr. Srinivasan is also a captain in the US Public Health Service. An infectious disease doctor, Dr. Srinivasan oversees several CDC programs aimed at eliminating healthcare-associated infections and improving antibiotic use. For much of his CDC career, Dr. Srinivasan ran the healthcare outbreak investigation unit, helping hospitals and other healthcare facilities track down bacteria and stop them from infecting other patients. Dr. Srinivasan leads the CDC’s work to improve antibiotic prescribing and works with a team of CDC experts researching new strategies.Topic: “Antibiotic Stewardship- Improving Antibiotic Use to Combat C diff.”

9:15 – 9:45 2:15 – 2:45 Clifford McDonald, MD

Dr. McDonald graduated from Northwestern University Medical School. He completed a medical microbiology fellowship at Duke University and is a former member of CDC’s Epidemic Intelligence Service. Dr. McDonald is currently the Associate Director for Science in the Division of Healthcare Quality Promotion at the CDC. He has first authored or co-authored over 100 peer reviewed publications on subjects related to healthcare and infectious disease epidemiology Dr. McDonald joins fellow world-renowned topic experts to discuss the burden of C. difficileinfections with the risk factors pertaining to current and emerging treatment options along with the importance of applying evidence-based clinical approaches to the prevention of a C. difficile infection (CDI), one of the leading community and healthcare-associated infections.Topic: “Challenges and Opportunities Posed by Current Diagnostics
for Clostridium difficile Infection”

9:45 – 10:15 2:45 – 3:15 Barley Chironda,, RPN, CIC

Barley Chironda a Nurse, National Healthcare Sales Director and Infection Control Specialist Clorox Canada, Social Media Manager of IPAC Canada, and the current President of IPAC- GTA. Mr. Chironda is certified in Infection prevention and control (CIC™) and has worked extensively in Infection Control. He is typically found engaged in motivating hospital staff, patients and the public on proper infection prevention practices. Mr. Chironda’s roles allow great participation in quality improvement interventions related to patient and public safety. Therefore Barley has been an integral to the successful decline in Clostridium difficile infections through implementing innovative technology and quality improvement behavioral change.Topic: “The C.diff.. Disinfection Debate: To Use
Or Not To Use Sporicidal Disinfectants Every-Time In Healthcare Facilities.”

10:15 -10:45 3:15 – 3:45 Dale Gerding, MD

Dr. Dale Gerding, Professor of Medicine at Loyola University Chicago Stritch School of Medicine in Maywod, Illinois and Research Physician at the Edward Hines Jr. VA Hospital. Prior to his present position Dr. Gerding was Chief of Medicine at VA Chicago, Lakeside Division, and Professor of Medicine at Northwestern University Feinberg School of Medicine. He is an infectious diseases specialist and hospital epidemiologist, past president of the Society for Healthcare Epidemiology of America and past chair the antibiotic resistance committee of SHEA. He is a fellow of the Infectious Diseases Society of America and past Chair of the National and Global Public Health Committee and the Antibiotic Resistance Subcommittee of IDSA. He served as a member of the Board of Directors of IDSA from 2005-2008. He is a Master of the American College of Physicians and the 2013 recipient of the William Middleton Award, the highest research award given by the Department of Veterans Affairs. He is a member of the American Society for Microbiology, and is board certified in Internal Medicine and Infectious Diseases. His research interests include the epidemiology and prevention of Clostridium difficile disease, antimicrobial resistance, and antimicrobial distribution and kinetics. He has been a Merit Review funded research investigator in the VA for over 40 years and is the author of over 400 peer-reviewed journal publications, book chapters, and review articles. He holds patents for the use of non-toxigenic C. difficile for the prevention and treatment of this disease.Topic: “Non-toxigenic Clostridium difficile for Prevention of CDI”

10:45 – 11:15 3:45 – 4:15 Richard Vickers, PhD

Dr. Richard Vickers is the Chief Scientific Officer, Antimicrobials and Programme Lead for CDI,
Summit Therapeutics. He joined Summit in 2003 and during his time has worked in a variety of roles involved in the development and management of various antibacterial therapeutic programs. This includes leading the discovery and development of ridinilazole, the investigational antibiotic for the treatment of C. difficile infection. Prior to joining Summit, Dr Vickers undertook postdoctoral research studies with Professor Stephen Davies at the University of Oxford and held a Stipendiary Lectureship in organic chemistry at St. Catherine’s College in Oxford. Dr Vickers received a Ph.D. in organic chemistry from the University of Reading and a B.Sc. in chemistry from King’s College London.Topic: “Ridinilazole; A Selective Therapy for the Treatment
of C. difficile Infections (CDI)”

11:15 – 11:45 4:15 – 4:45 Simon Cutting, PhD

Professor Cutting of Molecular Microbiology at Royal Holloway, University of London is a bacterial geneticist with over 25 years of experience with Bacillus since graduating from Oxford University with a D. Phil in 1986. His D.Phil was on understanding the genetic control of spore formation in Bacillus Clostridium difficile.. His other expertise is in the use of Bacillus spores as probiotics and has a number of contracts and consultancies with European and US companies in the food and feed sectors.Topic: “Thwarting the Opportunist: An Anti-adhesion
Vaccine That Prevents C.difficult Colonization.”

11:45 – 12:15 4:45 – 5:15 Hudson Garrett, Jr, PhD

Dr. Garrett is currently employed as the Global Chief Clinical Officer for Pentax Medical. He holds a dual Masters in Nursing and Public Health, Post-Masters Certificate as a Family Nurse Practitioner, a Post-Masters Certificate in Infection Prevention and Infection Control and a PhD in Healthcare Administration and Policy. He has completed the Johns Hopkins Fellows Program in Hospital Epidemiology and Infection Control, and the CDC Fundamentals of Healthcare Epidemiology program, and is board certified in family practice, critical care, vascular access, moderate sedation, infection prevention, legal nurse consulting, and a director of nursing in long term care. Dr. Garrett is also a Fellow in the Academy of National Associations of Directors of Nursing Administration in Long Term Care.Topic: “Improving Patient Safety and Reducing Clostridium difficile
through Collaboration with Clinical Nursing and Environmental Services Professionals”

Doors open at 7:15 a.m — Sign In and Continental Breakfast

Conference begins at: 7:30 a.m. – 5:00 p.m.

Raising C. difficile awareness is essential to build upon and advance existing knowledge and necessary for overcoming the challenges our healthcare communities are faced with today.

“None of us can do this alone — All of us can do this together”

Nearly half a million Americans suffered from Clostridium difficile (C. diff.) infections in a single year according to a study released February 25, 2015 by the Centers for Disease Control and Prevention (CDC). C. diff. is a leading cause of infectious disease death worldwide; 29,000 died within 30 days of the initial diagnosis in the USA. Previous studies indicate that C. diff. has become the most common microbial cause of healthcare-associated infections found in U.S. hospitals driving up costs to $4.8 billion each year in excess health care costs in acute care facilities alone.

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Clinical professionals gather for one day to present up-to-date data to expand on the existing knowledge and raise awareness of the urgency focused on a Clostridium difficile infection (CDI) —

Prevention

Treatments

Research

Environmental Safety

Clinical trials and studies

WITH

Microbiome research, studies

Infection Prevention

Fecal Microbiota Restoration and Transplants for Adults & Pediatrics

A Panel Of C. diff. Infection Survivors

Antibiotic Stewardship

Healthcare EXPO
……………………and much more.

You won’t want to miss out on this opportunity to learn from
International topic experts delivering data directed at evidence-based
prevention, treatments, and environmental safety in the C. diff.
and healthcare community.

Gain insights on September 20th that will not be available anywhere else with an opportunity to receive up-to-date data on major topics in this program being presented in one day.

5 Leading reasons to attend this dynamic conference:

Learn from leading healthcare professionals, clinicians, researchers, and industry.

Networking opportunities with new and reconnect with those in the healthcare community with similar interests.

Gain breakthrough results through research in progress and gaining positive results. Programs focused on Antibiotic-resistance such as the Antibiotic Stewardship making a difference. Front line developments in progress focused on C. diff. infection prevention, treatments, environmental safety.

Implement and share the knowledge well after the conference ends. Every attendee receives a booklet with guest speakers information, media to review audio programs, and Health Expo Sponsor information focused on the important agenda topics.

Embrace the opportunity, with all of the topic experts presenting, and hold the conference in the highest priority from the participation in this conference to an audience of medical students, and fellow healthcare professionals, who will benefit the most from the data and gain tools to overcome the barriers facing healthcare each day.

“The information and up-to-date studies shared at the 2015 conference added to an existing knowledge base that helps us to continue delivering quality care in the medical community.” Linda Davis, RN,BSN

……………………………………………………………………………………………………………..

REGISTRATION FEES:

$75.00 — Conference Registration

$30.00 — Student Conference Registration (Student ID To Be Presented At the Door)

We are pleased to welcome Barley Chironda, RPN, CIC to the C Diff Foundation in the role of Infection Prevention Advocate.

Barley Chironda, RPN, CIC is a Nurse and is the Social Media Manager of IPAC Canada and the current President of IPAC- GTA.

He is also the National Healthcare Sales Director and Infection Control Specialist with Clorox Canada. Mr. Chironda is certified in Infection prevention and control (CIC™) and has worked extensively in Infection Control. He is typically found engaged in motivating hospital staff, patients and the public on proper infection prevention practices.

Mr. Chironda’s roles allow great participation in quality improvement interventions related to patient and public safety. Therefore Barley has been an integral to the successful decline in Clostridium difficile infections through implementing innovative technology and quality improvement behavioral change.

Barley takes great pride in sharing information via social media and is often engaging the public on Twitter™ and LinkedIn™, partaking in resource distribution related to innovative and novel Infection prevention strategies.

The Division of Drug Information (DDI)- serving the public by providing information on human drug products and drug product regulation by FDA.

The U.S. Food and Drug Administration is advising that the serious side effects associated with fluoroquinolone antibacterial drugs generally outweigh the benefits for patients with sinusitis, bronchitis, and uncomplicated urinary tract infections who have other treatment options. For patients with these conditions, fluoroquinolone should be reserved for those who do not have alternative treatment options.

The new FDA ruling calling for restricted use of fluoroquinolones affects five prescription antibiotics: ciprofloxacin (Cipro), levofloxacin (Levaquin), moxifloxacin (Avelox), ofloxacin (Floxin), and gemifloxacin (Factive). All are also available as generics.

An FDA safety review has shown that fluoroquinolones when used systemically (i.e. tablets, capsules, and injectable) are associated with disabling and potentially permanent serious side effects that can occur together. These side effects can involve the tendons, muscles, joints, nerves, and central nervous system.

As a result, we are requiring the drug labels and Medication Guides for all fluoroquinolone antibacterial drugs to be updated to reflect this new safety information. We are continuing to investigate safety issues with fluoroquinolones and will update the public with additional information if it becomes available.

Patients should contact your health care professional immediately if you experience any serious side effects while taking your fluoroquinolone medicine. Some signs and symptoms of serious side effects include tendon, joint and muscle pain, a “pins and needles” tingling or pricking sensation, confusion, and hallucinations. Patients should talk with your health care professional if you have any questions or concerns.

Health care professionals should stop systemic fluoroquinolone treatment immediately if a patient reports serious side effects, and switch to a non-fluoroquinolone antibacterial drug to complete the patient’s treatment course.

Fluoroquinolone drugs work by killing or stopping the growth of bacteria that can cause illness.

We previously communicated safety information associated with systemic fluoroquinolone antibacterial drugs in August 2013 and July 2008. The safety issues described in this Drug Safety Communication were also discussed at an FDA Advisory Committee meeting in November 2015.

We urge patients and health care professionals to report side effects involving fluoroquinolone antibacterial drugs and other drugs to the FDA MedWatch program, using the information in the “Contact FDA” box at the bottom of the page.

“All antibiotic use contributes to the proliferation of antibiotic-resistant bacteria, and more than 2 million people are infected with antibiotic-resistant organisms each year in the United States, resulting in more than 23,000 deaths,” the 63-page report says. The US Centers for Disease Control and Prevention (CDC) released a report in 2013 estimating that about half of antibiotics prescribed each year are unnecessary.

To listen to the February 2016 Podcast: Using Antibiotics Wisely, How You Can Help In the Fight Against Antibiotic Resistance — with Doctors Laurie Hicks and Arjun Srinivansan from the CDC — click on the link below:

ASPs curb inappropriate antibiotic prescriptions with clinician education, better matching of antibiotics to infections (bug-drug matches), and rigorous authorization protocols for prescriptions, yet often are met with some resistance due to funding insufficiency, lack of dedicated staff or laboratory capability, and changes in accepted standards of care.

All except an academic hospital with a 20-year history of antibiotic stewardship interventions implemented their programs between 2006 and 2011. Though all demonstrated significant leadership and commitment to the interventions, each facility used practices and technology specific to their patient populations, outbreak history, staff availability, and lab capacity.

Administrative and physician support for stewardship

Outbreaks and high rates of healthcare-associated infections spurred operational support and funding for ASPs in four facilities, according to the report. Vibra Hospital of Northern California in Redding, Calif., and Sharp Villa Coronado Long-Term Care Facility in Coronado, Calif., were able to obtain support for nascent ASPs after linking antibiotic use to increases in healthcare-associated Clostridium difficile (C diff) infections.

Park Manor Nursing Home in Park Falls, Wis., and St. Tammany Parish Hospital in Covington, La., instituted their protocols after an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) and an increase in infections after coronary artery bypass grafts, respectively.

Blessing Hospital in Quincy, Ill., received institutional approval for an ASP after demonstrating the need for stewardship with a 4-month study on inappropriate use of aztreonam, tigecycline, daptomycin, and linezolid.

Staff roles and laboratory capacity

Most ASPs were led by at least one infectious disease or family practice physician and pharmacist who dedicated several hours per week to monitoring prescriptions and effectiveness of antibiotic treatment, the report explains. Exceptions were the program at Sharp Villa Coronado Long-Term Care Facility, which was led by pharmacists and pharmacy students, and the nurse-led ASP at Park Manor Nursing Home.

Because Park Manor had neither an on-site physician nor a pharmacist, nurses maintained detailed reports of patient infections, bacterial culture results, and antibiotic use, and then developed scripts to communicate patient status and care to physicians. The use of nursing staff to shepherd stewardship efforts, carry out active surveillance for urinary and respiratory tract infections, and communicate between patients and doctors reduced the number of unnecessary prescriptions, the authors said.

Both long-term care facilities were able to perform simple lab tests but had to send samples off-site for more complex testing and culturing. Several community hospitals lacked the ability to conduct on-site and/or rapid diagnostic testing and culturing, which increased waiting time for decisions about antibiotic therapy.

Lowering antibiotic use and infections

Ongoing treatment monitoring and patient interventions had the most measurable effects on inappropriate antibiotic use, the report states. Vibra Hospital found that changes to antibiotic regimens were needed in all 93 patient cases it monitored from May to June 2015. Vibra clinicians worked with the ASP to schedule antibiotic treatment stop dates for 46 patients, discontinue treatment for 42, review cultures and assign new prescriptions in 10 cases, and change four dosages because of new information on weight or kidney function.

Sharp Villa’s implementation of an antibiotic dosing protocol to prevent renal toxicity and ongoing therapy assessment lowered antibiotic use by 59%, with significant decreases in broad-spectrum antibiotics, vancomycin, antifungals, and C diff therapies. From 2011 to 2015, Escherichia coli susceptibility to levofloxacin at Sharp Villa rose from 24% to 54%.

Several facilities saw decreases in healthcare-associated C diff rates after ASP implementation. After educating physicians on substitutes for restricted or nonformulary antibiotics and transitions from intravenous to oral therapy, Williamson Medical Center in Franklin, Tenn., observed C diff rates fall from 26.3 infections per 10,000 patient-days in 2013 to 21.1 cases per 10,000 patient-days in 2014. At the same facility, the susceptibility of Pseudomonas aeruginosa to levofloxacin increased from 58% in 2009 to 79% in 2014.

St. Tammany’s antibiotic treatment surveillance and training interventions led to a fall in C diff rates from 9.6 per 10,000 patient-days in 2013 to 6.4 in 2014. Through active surveillance and close physician-pharmacist partnerships, the hospital was also able to reduce daily doses of daptomycin by 84%, linezolid by 79% tigecycline by 86%, and micafungin by 61%, and lowered total antimicrobial costs from $25.93 to $8.32 per patient-day.

The University of California, Davis Medical Center’s focus on prescription audits, bug-drug mismatches confirmed by culture, yeast colonization of sterile sites, and vancomycin resistance yielded a 23% reduction in C diff rates, which saved an estimated $23,540 in costs. Prescription decreases for 11 antibiotics targeted for intervention by the facility’s ASP led to cost savings of about $119,009 since the program began in 2011.

Opportunities and challenges

In most cases, ASPs at the 10 facilities proved effective when procedures were automated and when continual communication about antibiotic therapy was maintained between clinicians, pharmacists, and lab staff, according to the report. For example, Strong Memorial Hospital in Rochester, N.Y., held weekly antibiotic stewardship rounds between ASP members and six clinical services. Three hospitals observed increasing clinician acceptance of pharmacists’ prescribing recommendations over the course of their programs.

Barriers noted by some of the hospitals and centers included lack of dedicated staff time and funding for technology, including electronic health records in long-term care centers, that would more closely track patient therapies.

A recent action plan from the Obama administration proposed that all acute care hospitals and long-term care facilities implement ASPs, and California recently made it a requirement for acute care hospitals. Given the trend toward formalizing antibiotic stewardship and the benefits such programs can yield for patient care, microbial susceptibility, and facility costs, these case studies offer diverse methods and results to help burgeoning programs evaluate ASP feasibility in their institutions, the report says.

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